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The Use of Telehealth: Visiting Nurse Association of Greater Philadelphia

Organization Information

Description of Organization

The selected organization is the Visiting Nurse Association of Greater Philadelphia (VNA), and C. McEnvoy who was interviewed. The organization provides hospice and home care to the people of Philadelphia and its environs. It is one of the largest healthcare facilities in the region, and it offers services to about 50,000 people every year. The organization was founded in 1886 to offer nursing services to those in need in Philadelphia. The VNA has acquired accreditation from the Community Health Accreditation Program (VNA, 2014). In addition, it is recognized by Medicare and allowed to operate by Pennsylvania State (VNA, 2014).

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The VNA aims to provide quality care to all aged people regardless of their financial abilities. It offers care of the highest quality through its committed and dedicated healthcare staff. The personnel are well motivated and are given opportunities to grow professionally within the organization. A hardworking organizational culture of the VNA has enabled the organization to offer excellent home care and hospice services to thousands of old people annually (VNA, 2014).

The VNA has been at the forefront of the adoption of health information technologies (HITs). The organization’s management understands the value of the use of various applications of information technology (IT) by healthcare organizations across the world. One of the best HITs that the healthcare facility has adopted is telehealth. The VNA has reaped many benefits from the use of telehealth and plans to expand the information technology in the future (VNA, 2014).

Description of Health Information Technology System: Telehealth

Telehealth is the use of telecommunications tools to deliver healthcare services to healthcare consumers far from healthcare providers (Alston, 2009; Adams, 2010; Hannah et al., 2011). Some of the telecommunications tools may include telephone, robotic surgery equipment and the internet, among others. Telehealth could involve straightforward activities like two healthcare providers sharing their medical notes over the telephone. On the other hand, it could involve complex healthcare activities that require the participation of a multidisciplinary team of healthcare providers. For example, a healthcare team could conduct a robotic surgery by the use of telehealth. Telehealth is the advancement of telemedicine, which only concentrates on curative medicine rather than a holistic healthcare approach of preventive, curative, and promotive care (Alston, 2009; Adams, 2010; Hannah et al., 2011).

Alston (2009) asserts that the use of telehealth has the potential to promote patient care across the world. The health information system offers an excellent platform on which a physician can monitor a patient between hospital visits. The use of the information system has significantly reduced the number of patients hospitalized and the number of emergency visits (Adams, 2010; Hannah et al., 2011). The overall impact of the reduction in these numbers is an improvement of patients’ quality of life. The use of telehealth overcomes the distance barrier and improves access to quality healthcare services by many people in the community. This is due to the fact that healthcare providers can utilize telehealth to offer care to healthcare consumers between different geographical regions (Hannah et al., 2011). The use of telehealth also ensures that there are increased chances of accessing healthcare services from different specialists. In the past, patients could hardly receive specialist healthcare services from providers outside their localities. The use of telehealth has the potential to improve patient care tremendously in the future. Advancement in information technologies will be the key to successful applications of telehealth to improve healthcare (Hannah et al., 2011).

Reasons for Implementation of Telehealth

The VNA implemented telehealth to solve many healthcare challenges. The health information system was implemented by the organization to enable a small number of healthcare providers, particularly specialists, to offer care to many patients at different geographical locations. The adoption of telehealth has enabled the decreasing number of physicians to handle an increasing number of old patients in need of home care and hospice services offered by the VNA. Therefore, physicians offer clinical recommendations remotely to aged patients at different locations through the use of telehealth (Alston, 2009).

The organization also adopted the health information system to meet the increasing demand for care. The healthcare industry has experienced an increase in the demand for care from healthcare consumers. For example, it is estimated that the US will enroll 65 million babies in Medicare in the next 10 years. This implies that there would be more demand for healthcare. This is a global trend that has to be solved by adopting innovative healthcare solutions (Alston, 2009).

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The technology was implemented by the organization to help decrease healthcare costs and increase reimbursements. In the recent past, healthcare-associated costs have sharply increased and exceeded the speed of inflation. This has resulted in a general decline in the number of healthcare reimbursements. Telehealth increases access to healthcare providers who are knowledgeable about a particular health condition and/or disease. This accessibility helps a patient to avoid costs associated with unnecessary laboratory tests and readmissions, among others. This culminates in lower healthcare costs and better healthcare reimbursement trends.

The VNA implemented telehealth so that it could identify potential healthcare problems in patients and prevent them before they could impact their quality of life negatively. The organization achieves this through the use of remotely controlled healthcare monitoring devices and implantable tools that have features of detecting potential healthcare problems in a community.

Management of Telehealth System and its Structure

Prudent management and structure of telehealth are important to its overall goal of promoting patients’ quality of life through quality healthcare (Alston, 2009). The VNA manages the use of telehealth so that its applications can be available to healthcare consumers when they are needed. Within the VNA, there is a central server that manages and coordinates all incoming and outgoing communications. This is integral to the health information system because it facilitates a smooth flow of healthcare information. There is a health information system department, which manages the affairs of the telehealth system. The department is characterized by highly trained personnel who are competent in software and hardware applications. The personnel ensures that there is prudent sharing of computing devices across different geographical locations, which are covered with the telehealth system. In case the telehealth system does not function well, the competent personnel uses their troubleshooting skills to bring the system back to normal functionality. The personnel is required to undergo regular training and enroll in short courses to be updated about advancements in the area of telehealth. Through the training, the personnel is equipped with the right knowledge about the most relevant standards and procedures in the use of telehealth to promote patient care. In addition, the management ensures that resources are available to sustain the functions of the telehealth system. For instance, financial resources are key to the running of telehealth systems and other health information systems. Therefore, the management should ensure that there is sustained availability of funds crucial for the running of the telehealth system (Alston, 2009).

The structure of the telehealth system is marked by system attributes. The system accommodates several applications like telephone conversations among physicians or between physicians and patients. Another feature of the telehealth system is video teleconferencing, which allows a team of healthcare providers to discuss healthcare issues about a patient in real-time. This is particularly important when a patient is in urgent need of care that could best be achieved through the participation of providers from different areas of healthcare. The telehealth system is characterized by about 6 main structural components. First, telenursing is a component of the system that enables the system to support nursing services to patients who are at different locations. Second, telepharmacy component is crucial to patients because it enables them to order medications and access information about medications remotely. Third, the teletrauma care component of the telehealth system is key to making trauma patients access specialist services from providers from different locations. Fourth, telepsychiatry component of the system allows patients with psychiatric problems to access care from psychiatrists remotely. Fifth, teleophthalmology is a crucial component of the telehealth system because it enables patients with visual problems to access care from ophthalmologists remotely (Alston, 2009).

Information System Application Design and Development

Planning and Implementation of Telehealth system

All health information systems should be carefully planned so that they would be successfully implemented (Kaufman, Roberts, Merrill, Lai & Bakken, 2006; Schlotzer & Madsen, 2010; Hannah et al., 2011). The VNA has different healthcare providers who offer different categories of patient care, but to achieve the organization’s goals. All providers within the facility were brought on board to give their views about the features of the telehealth system they would want. Research shows that planning and implementation of health information systems that involve end-users have higher chances of success than those that do not involve end-users (Hannah et al., 2011). The implementation process involved the following steps:

  1. Needs analysis
  2. System design review
  3. Implementation meeting
  4. Implementation
  5. Testing procedures
  6. Implementation assistance
  7. Structured on-going support


Different entities within a healthcare organization have different health information needs, and this may imply that they could use different applications of a health information system. Training is crucial for end-users to understand the various aspects of a HIT (Caballero & Hullin, 2010; Liaw & Gray, 2010; Hannah et al., 2011; Powell, Inglis, Ronnie & Large, 2011). Within the VNA, end-users are continuously trained about new and existing telehealth components. The training also re-emphasizes the importance of using the telehealth system. The training is arranged in such a way that staff using similar applications are trained at the same time (VNA, 2014). This usually categorizes staff on the basis of departments within the facility. However, training sessions featuring general applications and components of the system are also offered to all staff (VNA, 2014).


Security issues associated with the use of a HIT could impact the application negatively (Darkins, 2012). For the continued smooth running of a HIT, the management should address various security issues that arise from a HIT (Darkins, 2012). To address a patient’s data security issues, the VNA uses high-tech software and hardware that promote the safe handling of patient information. Also, the organization ensures that its employees adopt the requirements of HPAA. HPAA aims to promote patient information privacy and security (VNA, 2014). It also prohibits some forms of disclosures that could negatively impact patients. It sets circumstances under which patient information may be disclosed (Esterhuizen, 2006; Darkins, 2012). Therefore, personnel within the VNA are bound by law to adhere to the legal and ethical standards so that they may uphold the security of patient information (VNA, 2014).

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Costs and Budgeting

Financial costs greatly impact the implementation of a HIT. If financial costs required to implement a HIT are too much for an organization to afford, then the implementation process of a HIT could stall. On the other hand, if financial requirements are met by an organization, then a HIT could be successfully implemented. Prudent budgeting is crucial to sound financial management and HIT implementation. Good budgeting practices are essential in allocating adequate funds to the various components of a HIT.

The first funds for implementing the telehealth system within the VNA were from the organization and well-wishers. The funds were meant to implement the system and further funding was pegged on the evaluation results of the adopted system. The budget for the HIT within the VNA is managed by the top management. However, the financial requirements for the system are proposed by the health information system department.

Organizational and Political Issues

Organizational issues are internal issues that could impact the funding of a HIT (Gruber, Cummings, Leblanc & Smith, 2009). In most cases, an organization has control over internal issues that could lead to poor performance. The management plays a crucial role in identifying internal issues that could lead to a reduction of funds dedicated towards the use of a HIT. How the management reacts to internal issues greatly determines sustained funding of HIT projects (Gruber et al., 2009). Political issues are external issues that could also negatively impact the funding of HIT projects. An organization does not have control over external issues. However, political issues do not impact the number of funds for the running of the telehealth system because much of the funds are from within the organization.

Internal organizational issues greatly impact the amounts and availability of funds for the running of telehealth systems (Gruber et al., 2009). For example, if the management expresses fears that there are limited funds for running activities within the facility, then this could also imply that funds for running the telehealth system would be slashed. On the other hand, increased funds within the organization could imply that telehealth could be allocated more funds for running it. Being a non-profit making organization, the VNA gets much of its funds from sponsors, donors, well-wishers and the government. Therefore, its quality of care could greatly impact the number of funds it receives from various sources (Gruber et al., 2009). If the organization offers exemplary care to patients, then the news spread far, and many organizations and individuals are motivated to fund the organization. Increased amounts of funds imply better funding for the telehealth system, which is key to promoting patient care (Gruber et al., 2009).

Technical problems and Downtime

HIT systems that are characterized by the least technical problems and downtime episodes have been shown to have a higher degree of usability than those that are marked by many technical problems and episodes of downtime (Gruber et al., 2009). Some technical problems are associated with the telehealth system. Software compatibility issues occur when some applications do not support IT tools used by end-users. This could be due to the fact that the software is of different versions with different features (Gruber et al., 2009). Limited technical expertise in some applications of the system has negatively impacted the running of the system. The applications could be in the different components of the system like telenursing, telepharmacy and teletrauma, among others. The system is characterized by a few cases of downtime. However, downtime is experienced when the internet connectivity is low. The system is also unavailable when it is being upgraded.

Upgrading the System

Upgrading health information systems is crucial in meeting user needs (Gruber et al., 2009). An upgraded system could handle more requests from users and support advanced applications. The VNA schedules telehealth system upgrading in intervals of one year. The health information system department conducts relevant research regarding advancements in telehealth. Trained personnel review published articles to assess their relevance for applications within the system. If they find that some applications could be feasible to be adopted within the HIT system, then they consider them for incorporation in their next schedule for upgrading the system. However, the team of HIT personnel could also upgrade the system before the scheduled time if the system is found to have limited usability due to outdated software and/or hardware applications (VNA, 2014).

Legal Issues and Legislation Regarding Telehealth

Recent healthcare reforms have emphasized the adoption of health information systems by healthcare facilities to foster improved patient care outcomes (Gruber et al., 2009). The reforms have positively impacted the telehealth system within the VNA because the personnel and healthcare consumers of the organization have increased their level of confidence that the use of telehealth system could result in better care. However, the following legal issues have slowed down the utilization of telehealth: licensure and type of practice, online prescribing issues, legal antitrust issues, and medical malpractice and liability issues, among others. The following laws have negatively impacted the use of telehealth: the federal fraud and abuse law, and the false claims Act.

It could be suggested that healthcare reforms should focus on promoting the use of telehealth by healthcare organizations due to the critical role that telehealth plays in promoting patient care. Telehealth-related legislation should focus on ensuring that care providers adhere to the legal standards of offering care using telehealth. However, it is suggested that the legislation should promote the adoption of telehealth by many healthcare facilities so that its benefits can spread across the world.

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Innovative Aspects of the System

How Telehealth has Enhanced Healthcare

The use of telehealth in the healthcare industry has greatly enhanced the quality of healthcare. The adoption of telehealth has facilitated the process of rehabilitating patients at home. Rehabilitation of patients who undergo complex surgery takes a lot of time and patients are faced with the difficulty of traveling to healthcare facilities for routine medical checkups. However, the use of telehealth has addressed the challenge. First, an assessment of rehabilitating patients is done remotely with the help of telehealth tools. Second, telehealth provides rehabilitating patients with online resources and monitors patients’ exercise activities using special pedometer readings (Hannah et al., 2011).

The use of telehealth has promoted the speed at which patients receive healthcare information crucial for understanding their health conditions. For example, research shows that the use of telehealth has helped patients to have lower risks of heart disease. This is because patients could communicate with their physicians online and be updated on ways of changing lifestyles and medications to use.

Telehealth has transformed healthcare in rural areas in many ways. Online consultations with physicians have been instrumental in preventing minor health conditions from worsening. For example, cataracts are identified and treated before they lead to blindness. Also, new mothers are able to access online information about childcare and management of medical needs.

The use of telehealth has greatly reduced health care costs. Traditional healthcare involves traveling to a physician’s office and doing much paperwork. This process is associated with a lot of costs. However, with the advent of telehealth, patients can remotely contact their physicians and receive appropriate healthcare at reduced costs (Hannah et al., 2011).

How Patients Have Accepted and Reacted to Telehealth

Although the introduction of telehealth has been faced with some challenges, patients have reacted positively to the adoption of telehealth by the healthcare industry. This is evident in the increase in the number of patients who have adopted the use of telehealth tools to manage their care. Patients believe that HIT improves their quality of life in many ways. Many patients use the internet to communicate with their physicians in different locations. They use emails and other forms of telecommunications to contact their healthcare providers. Patients utilize telehealth to learn about various medications that could be used to manage their conditions. Many patients have advanced communication gadgets like mobile phones that support various telehealth applications. The rate at which patients have accepted the applications of telehealth in the healthcare industry has greatly contributed to the successes of the HIT. In the future, expansion of telehealth will be based on the benefits it would be offering patients. Increased healthcare benefits would result in increased acceptance of telehealth amongst patients (Keselman, Logan, Smith, Leroy & Zeng-Treitler, 2008).

Future innovations in the use of telehealth

To realize telehealth’s broad potential in the future, innovations should be utilized. Key innovations would be utilized to transform the vision of making telehealth an important healthcare application in the future (Keselman et al., 2008). Telehealth is expected to foster the conduct of biomedical research, telerobotic surgery, and telemonitoring, among others. These applications will be supported by enhanced collaborations that involve remote sharing of expensive equipment (Keselman et al., 2008). The VNA would adopt innovations based on scalable computational platforms that support applications from low-end computers. Simplified interface innovations that support software and hardware will benefit the VNA in the future. Remote 3-D visualization innovations would support telehealth training, education, and research. In addition, the use of telehealth could be promoted by adopting innovations that focus on non-invasive surgical procedures, which significantly reduce the period required by a patient to recover (Keselman et al., 2008). To choose innovations that would improve the quality of healthcare, innovations should be selected based on their benefits. This would be achieved through the appraisal of research articles published in peer-reviewed journals. The findings would be crucial in supporting evidence-based practice with regard to the use of telehealth.


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